Presented by Suharsono,MN

Definition of health

Health is astate of complete physical, mental and

social well-being, and not merely the absence of
disease or infirmity (WHO)

1. It reflects concern for the individual as a total person

rather than as merely the sum of various part.
2. It views health in the context of both internal and
external environment
3. It equates health with productive and creative living
Some interpretation of health
 Clinical model
• People are viewed as physiologic system with
related functions.
• Health is identified by the absence of sign and
symptoms of disease or injury.
• The opposite of health in this model is disease.
 Ecological model
• The host : a person or
group who may or may
not be a risk of acquiring
an illness or disease. Host
• The agent : any factor in
the environment that by
its presence or absence
can lead to illness or
disease
• The environment ,
including the extrinsic or
intrinsic environment, Environment Agent
which may or may not
predispose the person to
the development of
disease.
 Role performance model

• Health is defined in term of the individual’s ability

to fulfill his or her societal roles.
• Health has also been defined as the state of
optimum capacity of an individual for the
effective performance of his roles and tasks.
• Sickness is assumed as the inability to perform
one’s work.
 Adaptive model

• Health is a creative process to adapt to their

environment.
• Health is defined as a state of wellbeing in which
the person is able to use purposeful, adaptive
responses and processes, physically, mentally,
emotionally, spiritually, and socially in response
internal and external stimuli in order to maintain
relative stability and comfort and to strive for
personal objective and cultural goals.
 Eudaimonistic model

• This model incorporates

the most comprehensive
view of health. Self actualization need

• Health is viewed as a Self esteem need

condition of actualization
of person potential. Love and belonging need

• The highest aspiration of

people is fulfillment and Safety and security need
complete development.
Physiologic needs
 Factors influencing an individual’s
definition of health
• Developmental status
• Social and cultural influences
• Previous experiences
• Expectations of self
 Hettler’r continuum of total wellness to
premature death

Attitude
Risk clarification
Sign Education

Premature Total
death wellness

No risk Self
Disability actualization
Awareness
Symptoms
 Disease and illness

• Disease is a medical term, which can be

describe as an alteration in body functions
resulting in a reduction of capacities or
shortening of the normal life span.
• Illness is a personal state in which the
person feels unhealthy or ill.
 Variables affecting health
• Genetic makeup
• Race
• Sex
• Age and developmental level
• Mind body relationship
• Life style
• Physical environment
• Standards of living
• Culture
• Self concept
• Support network
• Geographic area of residence
 Factors influencing health behaviour

Individual Perceptions Modifying factors Likelihood of action

Perceived barriers
1. Importance of health to action
2. Perceived control 1. Demographic
variables
2. Interpersonal
3. Perceived threat of variables
specific disease 3. Situational Likelihood of taking
4. Perceived susceptibility variables preventive action
5. Perceived seriousness

6. Perceived benefits of Cues to action

preventive actions
7. Perceived value of early
detection
 The definition of paradigm

• Webster defines it first as "a pattern, example, or

model" and secondarily as "an overall concept
accepted by most people in an intellectual
community, as a science, because of its
effectiveness in explaining a complex process,
idea, or set of data."
• A paradigm also has been described as an
abstract view or perspective of a discipline, a set
of systematic beliefs, a world view, and a theory.
4 Components in nursing paradigm

Nursing

Health Person

Environment/ society
 Some questions may arise

• Does increased nursing care affect the level of

health of individual?
• Do changes within the environment affect the
health of the individual?
• Are individuals more affected more by the
environment or by nursing?
Watson’s theory and nursing’s
metaparadigm
Human being

Nursing Health

Environment/
Society
 Watson’s view of Human being

• …. A valued person in and

him – or herself to be
cared for, respected,
nurtured, understood, and
assisted; in general a
philosophical view of
aperson as a fully
functional integrated self.
The human is viewed as
greater than, and different
from, the sum of his or her
part.
 Watson’s view of health

Health has following three elements:

• A high level of overall physical, mental and
social functioning.
• A general adaptive-maintenance level of
daily functioning
• The absence of illness ( or the presence of
efforts that lead to its absence)
 Cont…Watson’s view of health

• True health care focuses on life style,

social condition, and environment.
• Health refers to unity and harmony within
the mind, body, and soul.
• Health is also associated with the degree
of congruence between the self as
perceived and the self as experienced.
 Watson’s view of environment/ society

• Society provide the values that determine how

one should behave and what goals one should
strive toward.
• Caring and nursing has existed in every society.
Every society has had some people who have
cared for others.
• Caring attitude is not transmitted from
generation to generation by genes. It is
transmitted by the culture of the profession as a
unique way of coping with its environment.
 Watson’s view about nursing
• Nursing is concerned with
promoting health, preventing
illness, caring for the sick and
restoring health
• Nursing as … a human
science of person and human
health and illness
experiences that are
mediated by professional,
personal, scientific, esthetic
and ethical human care
transactions.
 Caring concept

• Humanistic caring from the moral point of view.

• Professional nurse caring emphasizes on
sustaining and improving the health and well-
being of client, humanistic-scientific combination,
culturally diverse and universal, a special way of
being, knowing, doing with the goal of protection
and enhancement of human dignity, the
synthesis of motor component, cognitive
component, an affective component and a
cultural component.
 Cont…

• Humans cannot be treated as objects, …

humans cannot be separated from self, other,
nature, and the larger universe.
• The caring-healing paradigm is located within a
cosmology that is both metaphysical and
transcendent with the co-evolving human in the
universe.
• The context calls for a sense of reverence and
sacredness with regard to life and all living
things.
 Elements of caring
• Compassion : Love and friendship, being concerned for
another.
• Communication : All aspects including verbal, non verbal
and physical contact.
• Concern : Actual instances when uses the words.
• Competence : The ability to use cognitive, affective and
psychomotor attribute that are particular to that clinical
situation.
• Commitment : Doing things they did not want to do.
Expressing of the activity of love not showing the bias.
 Cont….

• Confidence : Being able to do things without

doubting yourself
• Conscience : Taking account of their actions.
Looking at the person as an individual deserving
of respect.
• Courage : When stood up for patient, and spoke
to other staff on behalf of the patients.
 7 assumption about science of caring

1. Caring can be effectively demonstrated and

practiced only interpersonally.
2. Caring consists of carative factors that result in
the satisfaction of certain human needs.
3. Effective caring promotes health and individual
or family growth.
4. Caring responses accept a person not only as
he or she is now but as what he or she may
become.
 Cont…..
7 assumption about science of caring
5. A caring environment is one that offers the
development of potential while allowing the
person to chose the best action for himself or
herself at a given point in time.
6. Caring is more “ healthogenic” than is curing.
The practice of caring integrates biophysical
knowledge with knowledge of human behaviour .
7. The practice of caring is central to nursing
 The key concepts of the Model of
Whole-Person Caring
• Sacredness of being
• Therapeutic partnering
• Self-care and self-healing
• Optimal whole-person nourishment
• Transformational healthcare leadership,
• Caring as sacred practice.
Model of Caring
Cont…
Cont…
Caring of the whole person
• Any profession that loses its values becomes heartless;
any profession that becomes heartless becomes
soulless. Any profession that becomes heartless and
soulless, becomes [Worthless].
Human caring values becomes an economic
as well as human resource for nursing and
systems alike
• From economics to professional practice that is based
on morality-ethics-values
• From mechanical cure approaches to spiritualizing of
health and healing processes
• From rote, atheoretical professional routines of nursing
practice to more conscious, intentional caring-theory-
guided professional actions
• From artificial "hospitality" environments to authentic
healing environments
• From corporatization of health to public covenant for
healthy citizenry
• From industrial product line models of "managed care" to
relationship-centered caring-healing partnerships, at
multiple levels
 Framework of transpersonal caring-
healing
• The whole caring-healing consciousness is contained
within a single caring moment
• Human caring and healing processes-or noncaring
consciousness-of the practitioner is communicated to the
one being cared for
• Caring consciousness transcends time, space, and
physicality-that is, caring goes beyond the given
moment, and situation, and informs the future
experiences of practitioner and patient
• Caring-healing consciousness is dominant over physical
illness and has the potential to help the patient access
the healer within, or potentiates inner healing processes
 Cont…Framework of transpersonal
caring-healing
• One's (caring) intentionality and consciousness
energetically affects the "whole field," for
example, thoughts that are positive, such as
love, caring, joy, compassion, affection, and
forgiveness, have a higher frequency of energy.
Likewise, thoughts that create emotions such as
anger, hatred, jealousy, and fear have low-
frequency energy and therefore lower the
frequency of the system.
 when patients experienced caring, the
following consequences were reported:
• Emotional-spiritual well-being (dignity, self-
control, personhood)
• Physical lives enhanced, lives saved,
increase in safety
• Decrease in costs
• Increase in trust relationships, comfort,
and family support
 When patients experienced noncaring, the
following consequences were reported:
• Humiliation, fear, lack of control
• Despair, helplessness, alienation,
vulnerability
• Lingering bad memories
• Decreased healing
 The following consequences were present
when nurses were practicing caring:
• Emotional-spiritual sense of accomplishment,
satisfactions, purpose
• A sense of gratitude, fulfillment, wholeness, self-
esteem
• Ability to live their own philosophy
• Greater respect for life, death
• Ability to be more reflective
• A love of nursing
• Desire for increased knowledge
Nurses who were not practicing caring
reported the following:
• Being hardened, oblivious, robot-like
• Feeling depressed, frightened
• Feeling worn down, etc
 References
Watson, J (1995) in George, J ( 1995), Nursing
theories: The base for professional nursing practice,
Prentice Hall International, Inc
Adeline, FR ( 2000) Watson’s Philosophy, science,
and theory of human caring as a conceptual framework
for guiding community health nursing practice, Advances
in Nursing science, 23(2), 34-49
Jill, WB ( 1996) Can caring for critically ill patients be
taught by reading novel?, Nurse educator, 21(5), 23 –
27.
Watson, J. (2005). Jean Watson and the theory of
human caring. Retrieved May 17, 2006, from
http://www2.uchsc.edu/son/caring/content/